Support Group for Black Women

This group is to explore the experiences and identity of being a Black woman in various spaces. You may be feeling stressed or anxious and find that friends, family, or close acquaintances just don’t understand. This group is for women that need support but are not in traumatic situations or currently in crisis. You may be seeking support for daily stressors from your life, relationships, society, or work. It's a good fit if you are overwhelmed with the impacts school, parenting, peers and romantic relationships or the intense racial climate. This group is not a good fit if you are in a state of crisis, have been diagnosed with moderate to severe depression, have a mood disorder or personality disorder diagnosis, or if you have an ongoing, untreated mental challenge or illness that is not being treated by an individual licensed professional.

If you still have questions please contact me at 770-294-4006 or want more information about the group please visit the group page:Empowered Circle Support Group for Black Women

NOTE: This is a new group that is actively being filled. Once the minimum number is reached, all accepted participants who responded will be emailed with further information and your client portal will be set up.

Name*

First NameLast Name

E-mail*

example@example.com

Phone Number

Format: (000) 000-0000.

I understand that this group is for black women. (Please stop here if you are not a black women and reach out to see if we have another group that can accommodate you.)*

YesNo

Have you ever participated in a support group before? If yes, what was that experience like? Was there anything in your previous you were concerned about?

Are you able to commit to maintaining confidentiality and respecting the boundaries of others in the group and understand the need to be comfortable sharing? (This is critical in maintaining trust, connection, and rapport in the group.)*

YesNo

This group is designed for skill-building and community support, not trauma processing or crisis intervention. Can you confirm you're seeking support for daily stressors, anxiety, frustration (work, relationships, parenting, racial climate) rather than acute crisis care?**

Yes, I'm seeking support for daily stressors and skill-buildingNo, I need more intensive individual care right now

Which statement best describes your current mental health situation?* (Select the one that applies most)*

I'm managing daily stress/anxiety but not in crisis.I have a mental health diagnosis (depression, PTSD, mood disorders, personality disorder etc.) AND I'm actively in treatment with a therapist or psychiatrist.I have a mental health diagnosis (depression, PTSD, mood disorders, personality disorder etc.) but I'm NOT currently in treatment.I'm currently experiencing a mental health crisis or severe symptoms.None of these apply to me

Have you experienced any of the following in the last 6-12 months?* (Check all that apply)*

Hospitalization for mental health reasonsActive suicidal thoughtsSevere depression that significantly affects daily functioningUntreated substance dependenceActive psychosis or severe mood episodesNone of the above

I understand that this group is a support group that is not covered by insurance and I will have to pay out of pocket. I understand I can use my HSA/FSA funds and any debit or credit card.*

YesNo

I understand this group meets weekly online for 8 consecutive weeks, then takes a 1-week break. Group sessions $95/weekly via autopay.You will have a 30-minute individual check-in session, that you can utilize during the group break week. I understand there is an 8-week minimum and understand I will be charged $95/Weekly on autopay.*

Yes, I understandNo

The group meets has two meeting times Monday. Which group time would you prefer if this group ends up being a good fit. If none of those times work please add a time that does.

Meeting Time

Signature: (By signing this form I understand that I am being considered for group enrollment and that once accepted I still need to complete all paperwork to gain access to the group. Please look out for all emails once your client portal is set up)*

Date of Signature*

Once you are enrolled in the group it is important to watch out for your welcome email and choose what group time is best for you. Once the group starts please be sure you have access to a private and quiet space with a stable internet connection for online sessions? (You can access the virtual group where it is convenient for you as long as you have privacy, not in a moving vehicle, and can help maintain your confidentiality and others in the group.) I understand that I am signing up for this group but I am not in the group until I have set up my client portal and have completed all my paperwork

This group is actively being filled and as soon as we have 2 or more women sign up we will get started.

I can't wait to meet you!!

EMPOWERED TRANSITIONS COUNSELING

www.empowertransitions.com

770-294-4006

Please leave any questions, suggestions, or concerns you can leave them here or text me at 770-294-4006. For more information about the group, please check out the group page.

Support group for Black Women